Provider Demographics
NPI:1659619971
Name:PRIME MED HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:PRIME MED HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-441-2406
Mailing Address - Street 1:32260 ALVARADO BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4004
Mailing Address - Country:US
Mailing Address - Phone:510-441-2406
Mailing Address - Fax:510-487-1273
Practice Address - Street 1:32260 ALVARADO BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4004
Practice Address - Country:US
Practice Address - Phone:510-441-2406
Practice Address - Fax:510-487-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health